Provider Demographics
NPI:1922099381
Name:SUMMERLIN LANE NURSING HOME INC
Entity Type:Organization
Organization Name:SUMMERLIN LANE NURSING HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-281-5188
Mailing Address - Street 1:1408 SUMMERLIN LN
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-2529
Mailing Address - Country:US
Mailing Address - Phone:318-281-5188
Mailing Address - Fax:318-283-2989
Practice Address - Street 1:1408 SUMMERLIN LN
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-2529
Practice Address - Country:US
Practice Address - Phone:318-281-5188
Practice Address - Fax:318-283-2989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA291314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1513229Medicaid
LA1513229Medicaid